MRI lower back without contrast at Good Samaritan Hospital. CPT 72148.
What Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated June 29, 2026.
Outpatient / ER
$4,342cash price (self-pay)
$4,342list price
$296–$14,689range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Beacon Medicare | Beacon Medicare | $296 |
| Hamaspik (Mcr) | Hamaspik (Mcr) | $296 |
| Medicare Managed | Medicare Managed | $296 |
| Mvp Gold (Mcr) | Mvp Gold (Mcr) | $296 |
| Tricare | Tricare | $298 |
| Medicare | Medicare | $298 |
| Emblem Ghi/Hip Medicare | Emblem Ghi/Hip Medicare | $302 |
| Affinity By Molina Mcr | Affinity By Molina Mcr | $311 |
| Health First Medicare | Health First Medicare | $317 |
| Beacon Exchange | Beacon Exchange | $356 |
| Beacon Commercial | Beacon Commercial | $385 |
| Aetna HP Network | Aetna HP Network | $412 |
| Emblem Select Care (Exchange) | Emblem Select Care (Exchange) | $415 |
| Aetna Employee | Aetna Employee | $422 |
| Aetna | Aetna | $459 |
| Emblem Ghi/Hip PPO | Emblem Ghi/Hip PPO | $488 |
| Cigna PPO | Cigna PPO | $496 |
| Geisinger Health Commercial/Exchange | Geisinger Health Commercial/Exc | $978 |
| SELF-PAY - CC 30% | SELF-PAY - CC 30 PerCent | $1,303 |
| Mvp Exchange | Mvp Exchange | $1,645 |
| Mvp HMO/PPO | Mvp HMO/PPO | $1,935 |
| Cdphp | Cdphp | $2,171 |
| Self-Pay - Cc 50% | Self-Pay - Cc 50 | $2,171 |
| Blue Cross Connection/Exchange | Blue Cross Connection/Exchange | $2,379 |
| Self-Pay | Self-Pay | $2,632 |
| Blue Cross Small Group | Blue Cross Small Group | $2,857 |
| Blue Cross HMO | Blue Cross HMO | $2,936 |
| Magnacare Standard | Magnacare Standard | $3,039 |
| Multiplan | Multiplan | $3,257 |
| Phcs | Phcs | $3,257 |
Inpatient
$4,342cash price (self-pay)
$4,342list price
$1,303–$3,039range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| SELF-PAY - CC 30% | SELF-PAY - CC 30 PerCent | $1,303 |
| Cdphp | Cdphp | $2,171 |
| Self-Pay - Cc 50% | Self-Pay - Cc 50 | $2,171 |
| Magnacare Standard | Magnacare Standard | $3,039 |
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